Postgrad Med J (1990) 66, 727 - 729
) The Fellowship of Postgraduate Medicine, 1990
At our Mother's Knee
Relationship of urinary pH to symptoms of 'cystitis' W. Brumfitt', J.M.T. Hamilton-Miller1, J. Cooper2 and A. Raeburn2
'Department of Medical Microbiology, The Royal Free Hospital School of Medicine, London NW3 2QG and 2Earnswood Medical Centre, Crewe CWI 2JR, UK. Summary: The pH of urine samples from patients suffering symptoms suggesting urinary infection (e.g. dysuria, frequency, urgency) was measured while the patients were symptomatic and again when they had become asymptomatic. There was no correlation between the urine pH and the incidence or number of symptoms. No differences were observed between either the distribution or means of urine pH values in symptomatic and asymptomatic patients. There were also no significant differences in either symptomatology or urine pH between patients with significant bacteriuria and those without significant bacteriuria. These results cast doubt upon the traditional (but unproved) belief that alkalinizing the urine helps to reduce symptoms of dysuria and/or frequency, whether or not associated with urinary infection. Introduction
It is widely believed in both medical and lay circles that the symptoms associated with acute urinary infections (frequency, dysuria and urgency) can be alleviated at least temporarily by the use of agents that alkalinize the urine.'-3 Sodium bicarbonate (readily available in most households), potassium citrate (mist.pot.cit. BNF and Effercitrate) and sodium citrate (Cymalon, Cystemme, Urisal) are examples of compounds used for this purpose. As a literature search for evidence of the efficacy of this treatment yielded only one paper,4 we felt that it deserved further study. An opportunity to do this, albeit by an indirect means, arose during the analysis of the results of a clinical trial carried out in general practice. The pH was determined of a specimen of urine collected from patients first with symptoms suggesting urinary infections, and again when they returned after their symptoms had disappeared. Correlation between the nature and number of symptoms with the urinary pH was investigated. Results showed that acidity of the urine was not associated with symptoms, which in turn suggests that making the urine alkaline may not be an effective symptomatic treatment for dysuria and frequency.
tion (usually frequency, dysuria or urgency) were entered randomly into a trial where they were given either single-dose therapy (3g fosfomycin trometamol) or conventional therapy [amoxycillin and clavulanic acid (Augmentin) 375 mg 8-hourly for 5 days]. These were the only medications taken. A mid-stream urine specimen (MSU) was collected from each patient and divided into three parts. The first was tested with N-Labstix (Ames) in the surgery, and pH recorded; the second portion was used to inoculate a dipslide (Orion) and 20ml volume of the third was added to 380 mg of boric acid in a Universal container (Sterilin). The dipslide and the borated specimen were posted to the laboratory at the Royal Free Hospital for microbiological investigation. Patients were questioned in detail about their symptoms, both before and 3 to 5 days after the end of the antibiotic treatment.
Results Urine pH in symptomatic patients
A preliminary
analysis showed that there were no significant differences between symptomatology in patients with and without significant bacteriuria. Patients and methods Data from all the patients were therefore pooled. The distribution of pH in MSUs from 128 female Patients attending their general practitioners' patients complaining of symptoms is shown in surgery with symptoms suggesting a urinary infec- Figure 1. The most commonly observed pH (the mode) was 6/6.5. There were no statistically significant relationships between the urinary pH and the Correspondence: Professor J.M.T. Hamilton-Miller, D.Sc. incidence of five reported symptoms, namely freAccepted: 13 March 1990 quency, dysuria, urgency, nocturia and haematuria
W. BRUMFITT et al.
728
100 40
E
0 .
|
30 30
90 80
70
,B60
20
Frequency
-
:
50
*
40
--
Dysuria
Urgency
N
LP
C
10
30
) The Fellowship of Postgraduate Medicine, 1990
At our Mother's Knee
Relationship of urinary pH to symptoms of 'cystitis' W. Brumfitt', J.M.T. Hamilton-Miller1, J. Cooper2 and A. Raeburn2
'Department of Medical Microbiology, The Royal Free Hospital School of Medicine, London NW3 2QG and 2Earnswood Medical Centre, Crewe CWI 2JR, UK. Summary: The pH of urine samples from patients suffering symptoms suggesting urinary infection (e.g. dysuria, frequency, urgency) was measured while the patients were symptomatic and again when they had become asymptomatic. There was no correlation between the urine pH and the incidence or number of symptoms. No differences were observed between either the distribution or means of urine pH values in symptomatic and asymptomatic patients. There were also no significant differences in either symptomatology or urine pH between patients with significant bacteriuria and those without significant bacteriuria. These results cast doubt upon the traditional (but unproved) belief that alkalinizing the urine helps to reduce symptoms of dysuria and/or frequency, whether or not associated with urinary infection. Introduction
It is widely believed in both medical and lay circles that the symptoms associated with acute urinary infections (frequency, dysuria and urgency) can be alleviated at least temporarily by the use of agents that alkalinize the urine.'-3 Sodium bicarbonate (readily available in most households), potassium citrate (mist.pot.cit. BNF and Effercitrate) and sodium citrate (Cymalon, Cystemme, Urisal) are examples of compounds used for this purpose. As a literature search for evidence of the efficacy of this treatment yielded only one paper,4 we felt that it deserved further study. An opportunity to do this, albeit by an indirect means, arose during the analysis of the results of a clinical trial carried out in general practice. The pH was determined of a specimen of urine collected from patients first with symptoms suggesting urinary infections, and again when they returned after their symptoms had disappeared. Correlation between the nature and number of symptoms with the urinary pH was investigated. Results showed that acidity of the urine was not associated with symptoms, which in turn suggests that making the urine alkaline may not be an effective symptomatic treatment for dysuria and frequency.
tion (usually frequency, dysuria or urgency) were entered randomly into a trial where they were given either single-dose therapy (3g fosfomycin trometamol) or conventional therapy [amoxycillin and clavulanic acid (Augmentin) 375 mg 8-hourly for 5 days]. These were the only medications taken. A mid-stream urine specimen (MSU) was collected from each patient and divided into three parts. The first was tested with N-Labstix (Ames) in the surgery, and pH recorded; the second portion was used to inoculate a dipslide (Orion) and 20ml volume of the third was added to 380 mg of boric acid in a Universal container (Sterilin). The dipslide and the borated specimen were posted to the laboratory at the Royal Free Hospital for microbiological investigation. Patients were questioned in detail about their symptoms, both before and 3 to 5 days after the end of the antibiotic treatment.
Results Urine pH in symptomatic patients
A preliminary
analysis showed that there were no significant differences between symptomatology in patients with and without significant bacteriuria. Patients and methods Data from all the patients were therefore pooled. The distribution of pH in MSUs from 128 female Patients attending their general practitioners' patients complaining of symptoms is shown in surgery with symptoms suggesting a urinary infec- Figure 1. The most commonly observed pH (the mode) was 6/6.5. There were no statistically significant relationships between the urinary pH and the Correspondence: Professor J.M.T. Hamilton-Miller, D.Sc. incidence of five reported symptoms, namely freAccepted: 13 March 1990 quency, dysuria, urgency, nocturia and haematuria
W. BRUMFITT et al.
728
100 40
E
0 .
|
30 30
90 80
70
,B60
20
Frequency
-
:
50
*
40
--
Dysuria
Urgency
N
LP
C
10
30
